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Table 6 Summary of studies – patient-level interventions

From: Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review

Study;

Design;

Country, setting;

Funding

Population;

Study period

Intervention & comparator (no. of participants)

TOLAC ratea

VBAC ratea

VBAC/TOLAC ratea

Population;

Study period

Cleary-Goldman (2005)

Prospective cohort with controls

US, tertiary care center

Non-industry funded

Women eligible for a TOLAC

12-month period

I: one-on-one VBAC counselling, in 2nd and 3rd trimesters (n = 95)

C: no extra counselling, standard care (n = 221)

I: 44 (46.3%)

C: 85 (38.5%)

I: 26 (27.4%)

C: 70 (31.7%)

I: 26 (59.1%)

C: 70 (82.4%)

Eden (2014)

RCT

US, clinics

Non-industry funded

Pregnant women with one prior CS, 18 years or older, pregnant with one fetus, low transverse uterine scar, and providers had given option of TOLAC

September 17, 2005-May 4, 2007

I: Evidence-based, interactive decision aid (n = 66)

C: two evidence-based educational brochures about cesarean delivery and VBAC (n = 65)

NR

I: NR (41.0%)

C: NR (37.0%), p = 0.724

NR

Fraser (1997)

RCT

Canada, hospitals

Non-industry funded

Women with single previous low transverse CS, gestational age < 28 weeks.

April 1992–November 1994

I: Verbal prenatal education program – pamphlet + 2 individualized contacts (n = 641)

C: Document prenatal education program – written information (n = 634)

I: 465 (72.5%)

C: 440 (69.4%);

RR 1.1 (95% CI 1.0–1.1)

I: 339 (52.9%)

C: 310 (48.9%);

RR 1.1 (95% CI 1.0–1.2)

I: 339 (72.9%)

C: 310 (70.5%)

Gardner (2014)

Non-concurrent cohort

Australia, metropolitan teaching hospital

Funding NR

Women with a single prior CS, presenting in their next pregnancy

2006 (before) & May 2009–October 2010

Grp 1 (2006): routine care, counselling for mode of birth on ad-hoc basis (n = NR)

Grp 2 (2009–2010): two combined management strategies – Risk Associated Pregnancy consultant & NBAC clinic (n = 396)

Grp 1: NR

Grp 2: 164 (41.4%)

VBAC rate for NBAC

Grp 1: NR (17.2%)

Grp 2: 107 (27.0%), p < 0.001

Grp 1: NR

Grp 2: 107 (65.2%)

Montgomery (2007)

RCT

UK, maternity units

Non-industry funded

Pregnant women with one previous lower segment CS, delivery expected at ≥37 weeks; most recent delivery is cesarean.

May 2004–August 2006

I 1: decision analysis aid (n = 235)

I 2: information program (n = 241)

C: usual care (n = 239)

NR

I 1: 88 (37.4%)

I 2: 70 (29.2%)

C: 72 (30.3%)

I 1 vs. C:

aOR 1.42 (95% CI 0.94–2.14), p = 0.22

I 2 vs. C:

aOR 0.93 (95% CI 0.61–1.41), p > 0.9

I1 vs. I2:

aOR 1.53 (95% CI 1.01–2.30), p = 0.11

NR

Wong (2014)

Prospective cohort

UK, district general hospital

Funding NR

Women with one previous lower segment CS, no contraindications for VBAC

12-month period commencing January 1, 2012

I: one-stop obstetrician-led cesarean education and antenatal sessions (OCEANS) (n = 188)

C: did not attend OCEANS (n = 78)

I: 108 (57.4%)

C: 33 (42.3%), p = 0.02

I: 59 (31.4%)

C: 20 (25.6%)

I: 59 (54.6%)

C: 20 (60.6%)

p = 0.69†

  1. no. number, TOLAC trial of labor after cesarean, VBAC vaginal birth after cesarean, US United States, I intervention, C comparator, RCT randomized controlled trial, CS cesarean section, NR not reported, RR relative risk, CI confidence interval, Grp group, NBAC next birth after cesarean, UK United Kingdom, aOR adjusted odds ratio, OCEANS obstetrician-led cesarean education and antenatal session
  2. aResults of statistical tests or summary statistics were extracted whenever these were reported within studies
  3. †study reports difference as p = 0.69 (Table 2) and p = 0.55 (abstract)
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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